Selection of Patients for Coronary Angiography and Coronary Revascularization Early after Myocardial Infarction: Is There Evidence for a Gender Bias?

作者：Harlan M. Krumholz, Pamela S. Douglas, Michael S. Lauer, Richard C. Pasternak · 发表于：Annals of Internal Medicine · 年份：1992 · DOI：10.7326/0003-4819-116-10-785 · 被引用次数：291 · 研究领域：Acute Myocardial Infarction Research、Sex and Gender in Healthcare、Diversity and Career in Medicine

OBJECTIVE: To determine whether a gender bias exists in the selection of patients for diagnostic and therapeutic cardiovascular procedures early after myocardial infarction. DESIGN: A retrospective cohort study. SETTING: A community-based tertiary care teaching hospital. PATIENTS: A total of 2473 consecutive patients with a principal discharge diagnosis of acute myocardial infarction and a peak creatine kinase MB fraction of at least 4%. MEASUREMENTS: Comparison of men and women regarding the frequency with which they underwent various cardiac procedures. RESULTS: Women had coronary angiography during hospitalization for myocardial infarction much less frequently than men (odds ratio, 0.55; 95% Cl, 0.46 to 0.65), but the age-adjusted rates were similar in women and men (odds ratio, 0.91; Cl, 0.75 to 1.12). An abnormal ejection fraction (less than 50%) was equally frequent in women and men who underwent left ventriculography (odds ratio, 0.85; Cl, 0.56 to 1.30). Among patients who had coronary angiography, women had a significantly lower rate of severe coronary artery disease, defined as either a left main stenosis of more than 50%, three-vessel disease, or two-vessel disease with a proximal left anterior descending stenosis of more than 70% (odds ratio, 0.67; Cl, 0.48 to 0.93). When adjustments were made for age, women had percutaneous transluminal coronary angioplasty as often as men (odds ratio, 1.16; Cl, 0.83 to 1.62) but had coronary artery bypass graft surgery significan...